title: Association between bleeding and mortality among women and men with high-risk acute coronary syndromes: insights from the Early versus Delayed, Provisional Eptifibatide in Acute Coronary Syndromes (EARLY ACS) trial.
abstract: BACKGROUND
  Female sex is an established risk factor for bleeding, which is an important safety end point in patients presenting with non-ST-segment elevation acute coronary syndromes (NSTE ACS). However, it is unknown whether the association between bleeding and mortality is modulated by sex in this patient population.
  
  
  METHODS
  We examined the interaction between sex and bleeding and 30-day mortality outcomes among 2,975 women and 6,431 men with high-risk NSTE ACS enrolled in the EARLY ACS trial. The Global Utilization of Strategies to Open Occluded Arteries (GUSTO) criteria were used to identify moderate or severe bleeds.
  
  
  RESULTS
  Women were older and had more comorbid disease compared with men. Bleeding rates were higher among women (8.2%) than among men (5.5%; P < .01). However, the association of bleeding and 30-day mortality was stronger among men (odds ratio 5.8, 95% CI 3.9-8.8) than among women (odds ratio 1.5, 95% CI 0.8-2.9; sex * bleeding interaction P < .01). Sex differences in the association of bleeding and mortality persisted in a landmark analysis of 120-hour survivors.
  
  
  CONCLUSIONS
  In a contemporary high-risk NSTE ACS cohort, women had higher bleeding rates than did men. Paradoxically, the association between bleeding and mortality was worse among men than among women.
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada. Electronic address: pkaul@ualberta.ca.
authors.forename: Padma
authors.initials: P
authors.lastname: Kaul
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Tanguay
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Westerhout
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Tricoci
authors.forename: C Michael
authors.initials: CM
authors.lastname: Gibson
authors.forename: Robert P
authors.initials: RP
authors.lastname: Giugliano
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004562:Electrocardiography; D000077542:Eptifibatide; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide